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| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| STATE OF OREGON |    |   |    | ) |   |  
CAPACITY CLAIMED BY SIGNER Though
statute does not require the Notary to fill in the data below, doing so may prove invaluable
to persons relying on the document. |
|   |    |  |    | ) ss. |   |
| COUNTY OF               
                       |    |  |    | ) |   |
|  |  |
| On
            , 2011, before me,
                                        
                                         
                            ,
personally appeared
                                         
                                         
                      , |   | ¨  Individual
¨  Corporate Officer(s) |
|     ¨ |   |   personally
known to me |   |                  
                                         
                     |
|   |   | **-or-** |   | ¨  Partner(s) |   | ¨  Limited
¨  General |
|     ¨ |   | proved to me on the basis of satisfactory evidence |   |   |